Summary
As first reported by our group in 1975, severe heart failure due to idiopathic dilated cardiomyopathy could be improved in patients receiving β-blocker therapy starting at a very low dose and followed by a stepwise increase. Since then, these results have been confirmed by our own group and by others, and similar results were also obtained in patients with other forms of cardiomyopathy, including ischaemic cardiomyopathy. In 13 separate studies involving a total of 651 patients with idiopathic dilated cardiomyopathy, β-blockade for 2 to 19 months (in addition to conventional treatment of heart failure, including angiotensin converting enzyme inhibitor therapy), significantly improved cardiac function. These studies were performed using metoprolol, bucindolol, labetalol and practolol. Eight studies investigated the effects of long term β-blocker treatment in patients with heart failure and cardiomyopathy due to coronary artery disease, valvular heart disease, diabetes and doxorubicin therapy. A total of 128 patients were treated with metoprolol, carvedilol or bucindolol for periods of 2 to 12 months. All studies reported a significant improvement in cardiac function. Three studies reported results on survival and the need for cardiac transplantation. The first study published by our group reported improved survival in patients with idiopathic dilated cardiomyopathy treated with metoprolol plus digitalis and diuretics compared with a matched control group. In the more recent Metoprolol in Dilated Cardiomyopathy trial, metoprolol treatment in patients with idiopathic dilated cardiomyopathy resulted in an estimated 34% reduction in the number of primary end-points, total number of deaths, and the need for cardiac transplantation compared with placebo treatment. Recently, it was reported that bisoprolol in patients with heart failure due to various forms of cardiomyopathy caused a nonsignificant 21% reduction in mortality compared with placebo. However, larger studies are needed to further study the effects of β-blockers on the prognosis for patients with various forms of cardiomyopathy.
Similar content being viewed by others
References
Anderson JL, Gilbert EM, O’Connell JB, Renlund D, Yanowitz F, et al. Long-term (2 year) beneficial effects of β-adrenergic blockade with budindolol in patients with idiopathic dilated cardiomyopathy. Journal of the American College of Cardiology 17: 1373–1381, 1991.
Anderson JL, Lutz JR, Gilbert EM, Sorensen SG, Yanowitz FG, et al. A randomized trial of low-dose β-blockade therapy for idiopathic dilated cardiomyopathy. American Journal of Cardiology 55: 471–475, 1985.
Beta-blocker Heart Attack Study Group. The beta-blocker heart attack trial (BHAT). Journal of the American Medical Association 246: 2073–2074, 1981.
Currie PJ, Kelly MJ, McKenzie A, Harper RW, Lim YL, et al. Oral β-adrenergic blockade with metoprolol in chronic severe dilated cardiomyopathy. Journal of the American College of Cardiology 3: 203–209, 1984.
Das Gupta P, Broadhurst PA, Lahiri A. Improvement in congestive heart failure following chronic therapy with a new vasodilating β-blocker: carvedilol. Circulation 80 (Suppl. II): II–117, 1989
Eichhorn EJ, Bedotto J, Hatfield B, Deitchman D, Grayburn PA, et al. Improvement in contractile performance in patients with congestive failure by chronic β-blocker therapy with bucindolol. Circulation 80 (Suppl. II): 11–117, 1989
Eiswirth CC, Bowden RE, Kazamias T, Fowler M, Bristow MR. Treatment of adriamycin cardiomyopathy with metoprolol. Circulation 74 (Suppl. II): 310, 1986
Engelmeier RS, O’Connell JB, Walsh R, Rad N, Scanion PF, et al. Improvement in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: a doubleblind, randomised, placebo-controlled trial. Circulation 72: 536–546, 1985.
Gilbert EM, Anderson JL, Deitchman D, Yanowitz FG, O’Connell JB, et al. Chronic β-blocker therapy improves cardiac function in idiopathic dilated cardiomyopathy: a double-blind, randomized study of bucindolol versus placebo. American Journal of Medicine 88: 223–229, 1990.
Gilbert EM, Mestroni L, Anderson JL, Woodley SL, Bristow MR. Can response to β-blocker therapy in idiopathic dilated cardiomyopathy be predicted by baseline parameters? Circulation 80 (Suppl. II): 11-428, 1989
Heilbrunn SM, Shah P, Bristow MR, Valentine HA, Ginsburg R, et al. Increased beta-receptor density and improved hemodynamic response to catecholamine stimulation during long-term metoprolol therapy in heart failure from dilated cardiomyopathy. Circulation 79: 483–490, 1989.
Hjalmarson Å, Elmfeldt D, Herlitz J, Holmberg S, Málek I, et al. Effect on mortality of metoprolol in acute myocardial infarction. A double-blind randomised trial. Lancet 2: 823–827, 1981.
Ikram H, Fitzpatrick D. Double-blind trial of chronic oral β-blockade in congestive cardiomyopathy. Lancet 2: 490–492, 1981.
ISIS-1 (First International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous atenolol among 16027 cases of suspected acute myocardial infarction: ISIS-1. Lancet 2: 57–66, 1986.
Leung W-H, Lau C-P, Wong C-K, Cheng C-H, Tai Y-T, et al. A double-blind crossover trial of labetalol in patients with idiopathic dilated cardiomyopathy. Circulation 80 (Suppl. II): II–118, 1989
MIAMI Trial Research Group. Metoprolol in acute myocardial infarction (MIAMI). A randomised placebo-controlled international trial. European Heart Journal 6: 199–226, 1985.
Nemanich JW, Veith RC, Abrass IB, Stratton JR. Effects of metoprolol on rest and exercise cardiac function and plasma catecholamines in chronic congestive heart failure secondary to ischemic or idiopathic cardiomyopathy. American Journal of Cardiology 66: 843–848, 1990.
Norwegian Multicenter Study Group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. New England Journal of Medicine 304: 801–807, 1981.
Pollock SG, Lystash JC, Tedesco CL, Craddock GB, Smucker ML. Bucindolol — β-blockade with vasodilation improves congestive heart failure. Circulation 80 (Suppl. II): II–118, 1989
Sano H, Kawabata N, Yonezawa K, Hirayama H, Sakuma I, et al. Metoprolol was more effective than captopril for dilated cardiomyopathy in Japanese patients. Circulation 89 (Suppl. II): II–118, 1989
Swedberg K, Hjalmarson Å, Waagstein F, Wallentin I. Beneficial effects of long term β-blockade in congestive cardiomyopathy. British Heart Journal 44: 117–133, 1980a.
Swedberg K, Hjalmarson Å, Waagstein F, Wallentin I. Adverse effects of beta-blockade withdrawal in patients with congestive cardiomyopathy. British Heart Journal 44: 134–142, 1980b.
Swedberg K, Hjalmarson Å, Waagstein F, Wallentin I. Prolongation of survival in congestive cardiomyopathy during treatment with β-receptor blockade. Lancet 1: 1374–1376, 1979.
Waagstein F. The use of β-adrenergic blockade in the critically diseased heart. A study in acute myocardial infarction and congestive cardiomyopathy. Thesis, Faculty of Medicine, University of Göteborg, Sweden, 1976
Waagstein F, Blomström-Lundquist C, Andersson B, Hjalmarson Å, Wallentin I. Long-term effects of metoprolol in severe heart failure due to ischemic cardiomyopathy, primary valve disease and diabetes. Circulation 76 (Suppl. IV): IV–358, 1987
Waagstein F, Bristow MR, Swedberg K, Camerini F, Fowler MB, et al. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Results of the Metoprolol in Dilated Cardiomyopathy (MDC) Trial. A randomised, double-blind, placebo controlled multicentre study. Lancet 342: 1441–1446, 1993.
Waagstein F, Caidahl K, Wallentin I, Bergh C-H, Hjalmarson Å. Long-term β-blockade in congestive cardiomyopathy. Effects of acute and chronic metoprolol treatment followed by withdrawal and readministration of metoprolol. Circulation 80: 551–563, 1989.
Waagstein F, Hjalmarson Å, Swedberg K, Wallentin I. β-Blockers in dilated cardiomyopathies: they work. European Heart Journal 4 (Suppl. A): 173–178, 1983
Waagstein F, Hjalmarson Å, Varnauskas E, Wallentin I. Effect of chronic β-adrenergic receptor blockade in congestive cardiomyopathy. British Heart Journal 37: 1022–1036, 1975.
Woodley SL, Gilbert EM, Anderson JL, Deitchman D, Mealey P, et al. Differing effect of chronic β-blockade with bucindolol on cardiac function in patients with idiopathic vs ischemic cardiomyopathy. Circulation 80 (Suppl. II): II–118, 1989
Yamada T, Fukunami M, Ohmori M, Iwakura K, Kumagai K, et al. Which subgroup of patients with dilated cardiomyopathy would benefit from long-term β-blocker therapy? A histologie viewpoint. Journal of the American College of Cardiology 21: 628–633, 1993.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hjalmarson, Å., Waagstein, F. The Role of β-Blockers in the Treatment of Cardiomyopathy and Ischaemic Heart Failure. Drugs 47 (Suppl 4), 31–40 (1994). https://doi.org/10.2165/00003495-199400474-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-199400474-00006